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Enabling People in Northumberland to Improve Their Mental Health and Wellbeing

We are a friendly and committed group who are all passionate about empowering people to thrive and enjoy good mental health and wellbeing.

We are a local general counselling charity based in Ashington, Northumberland, who provide a range of services to those seeking to improve their mental health and wellbeing.

We are open Monday - Friday from 9am - 4:30pm, with our last counselling appointment starting at 3:30pm.

Please Note - We are not a Crisis Team nor are we open 24/7. Should you require immediate urgent help and/or we are closed, please click below for more options.

I Need Urgent Help

Here at Cygnus Support, we have a large team of volunteer and associate counsellors. We are always looking to expand this team further. If you are interested in joining or wish to find out more information, click the link below.

Volunteer/Get Involved

Below are some quotes regarding the services we have provided:

Client – "Cygnus Support were brilliant, the counselling helped me through a difficult time and I learned strategies for coping in the future"

Volunteer – "Volunteering at Cygnus Support is such a positive experience. I support clients to improve their mental health and wellbeing and also get the chance to continue with my own learning and development"

Today's date

What Service is Required? * Counselling
Bereavement Counselling
Bereavement Group
Other (please specify)

Client Details (In the case of a self-referral please provide your own details)

Title

First Name *

Last Name *

Address *

Town *

Postcode *

Date of Birth *

Age *

Safe Telephone Number *

If someone else answers the phone, who should we say we are?

Email *

In addition to telephone what are your/the clients’ other preferred methods of contact? (Please select all that apply) * Letter
Text
Voicemail
Email

Have you/the client accessed Cygnus Support before? *

Additional Information

Is the referral a Young Person?

GP Practice *

GP Name

Location

Telephone Number *

Referrer's Details

Name *

Organisation / please use your own details if you are self-referring *

Address *

Town *

Postcode *

Contact Number *

Email address *

How Did you hear about Cygnus Support? *

At times it may be necessary for another worker within the referring organisation to request information or updates about you/the client – are you/the client happy for us to share information with anyone within the referring organisation?*

Do you give your permission for us to share information about you with a parent/guardian?*?

If you answered yes to the question above please give details of the parent/guardian below:

Name

Their relationship to you

Their contact telephone number

Why do you/the client need counselling now? *

What other services are involved with the client? *

Children or Adult Social Care

Child & Young People Service

Community Mental Health Team or Talking Matters

Crisis Team

Addiction Services

Police or Probation

Victim's First

Other (please specify)

Risk Assessment and Management Details *

Known Risks

Staff or Public

How is this managed?

Self

How is this managed?

Children

How is this managed?

Other Service Users

How is this managed?

Additional Information - Client Needs

Availability for appointments – please select the days of the week you are available. *

Please note: we will try to accommodate sessions within your selected days wherever possible – we would ask you to be as flexible as possible because if you have limited availability this might mean you have to wait longer.

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred counselling delivery*

Do you/the client have difficulty using stairs? *

Would you/the client prefer a Male or Female counsellor?*? *

Are you/the client currently working? *

Is there anything else you think we need to know? Do you/the client have any additional needs / learning difficulties? Please indicate if you/the client will need support to complete our assessment pack.

By completing this form you are confirming that you have read and understood the above message, and that you are giving consent for your information to be kept and stored by Cygnus Support in line with GDPR and our Privacy Policy. Visit https://www.cygnussupport.com/privacy-policy/ for our privacy policy or alternatively you can request one via email at admin@cygnussupport.com

[*] denotes a required field

Cygnus Support, 1 Council Rd, Ashington, Northumberland, NE63 8RZ

(01670) 853977